Each youth or youth group must bring their own adult leaders, and all adults must complete the basic safe church training (www.shieldthevulnerable.org). Adult accompanying youth must stay for the whole event overnight. If you don't belong to a youth group, and adult leader from your congregation who has completed the safe church training may accompany you, or contact Caren Miles, carenm@diocal.org or assistance.

Nightwatch costs $20 per person for snacks, breakfast and other costs, but scholarships are available!

Please note your congregation or group you are attending with so that we can be sure there is a chaperone there at Nightwatch for you. Each congregation/group must provide at least one adult chaperone for the overnight.

Parent/Guardian Name
*FirstLast

Parent/Guardian Name
FirstLast

Parent/Guardian Email
*

Parent/Guardian Phone
*###-###-####

Payment Options ($20)
*

Credit Card through PayPalPay by check Requesting scholarship to attend

The cost for Nightwatch is $20, but no one is turned away. Scholarships are available; Caren Miles will contact you if you click "requesting scholarship."

When you hit submit, you will be taken to a PayPal page; if you are paying by check, please disregard this.

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Permission and Liability Waiver

In order for your youth to participate in this event, you must complete, electronically sign, and submit the following statement of consent / liability waiver and medical release. As parent or legal guardian, you remain fully responsible for the actions and conduct of your youth.

I hereby consent to participation by child, a minor, in the Nightwatch in the Cathedral April 29-30, 2016.

In consideration of my youth being allowed to participate in this field trip, I hereby agree on behalf of myself and my youth, to release the Diocese of California and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively “Releases”) from any and all claims, including negligence, which may be asserted by me or my youth,
or on behalf of my youth, arising from or relating to my youth’s participation in the field trip. In the event this release on behalf of myself and/or my youth is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releases from any and all claims, including negligence, which may be asserted by me or my youth, or on behalf of my youth, arising from or relating to
my youth’s participation in the field trip. This release or indemnification does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any claim, but this Release or Indemnification shall apply to the extent of any self- insurance or deductible applicable to any claim.

Permission and Liability Waiver Consent
*

I give my consentI do not give my consent

Parents/Guardians: Type your full name below to serve as an electronic signature.
*

Medical Release

I/we, the parent(s) or legal guardian(s) of the above named child, a minor, hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by,
and is to be rendered under the general or special supervision of any licensed medical personnel on staff of any licensed hospital. This authorization is given in advance of any specific diagnosis, treatment, or hospital care required, but is given to provide authority and power to render care, which is deemed advisable in the best judgement of the physician.

Medical Release Consent
*

I give my consentI do not give my consent

Parents/Guardians: Type your full name below to serve as an electronic signature.
*

Current Medications or Medical Needs

Please send medications in the ORIGINAL PRESCRIPTION CONTAINER, not a day of the week pillbox.

Medications will be collected by a designated first aid and medication chaperone, locked and dispensed as directed on this form.

Birthdate of Minor
*MM/DD/YYYY

Date of last tetanus shot
*

Allergies

Current medications, with dosages, and times taken.

Special Needs (physical, emotional, mental health)

Insurance Provider

Insurance Policy Number

Photo and Audio Release

I give the Episcopal Diocese of California permission to take photographs, videotape, and/or record the voice of my child, a minor, and to use those images and recordings in diocesan publications only.

Photo and Audio Release
*

I agreeI agree to photo release onlyI do not agree

Community Agreement

Diocesan Youth Events seek to be safe spaces for youth to live as their authentic selves. To that end we establish a community agreement that youth must agree to adhere to while at Diocesan Youth Events. Adult Leaders agree to the following as well.

I aree:

1. NOT to leave designated program spaces;
2. NOT to bring or use alcohol or any illegal drugs;
3. NOT to participate in any violent behavior, including the possession of weapons;
4. NOT to participate in any sexual behavior;
5. TO respect the needs and property of other participants and staff;
6. TO participate in community activities, including chores.

I understand these agreements are designed to provide a safe and supportive community at all events I also understand that if I break one of these agreements,
I will have broken the trust of the community, and may be asked to leave at the expense of my parent(s)/guardian(s).

Youth Participant's Name, acknowleging they have red the above Community Agreement
*FirstLast